In this time of apparently wrenching change in the environments in which
academic health centers must exist, it is pertinent to ask, What is the single
greatest challenge facing these institutions as they enter the third millennium?
To answer that question, it is important first to consider several key aspects
about this changing environment.

The dramatic changes affecting health care and higher education in the
United States reflect much of what is happening in the rest of society. American
society is moving from the security of a belief in everlasting material progress
(called modernism), based on the principles of the
Enlightenment as expressed through the successes of the capitalistic, democratic,
industrialized nations, and is entering a time of confusion (called postmodernism), characterized by decreasing faith in the
old principles and with no new governing paradigm readily available. Modernism
has brought society many advantages, but it does not provide meaning or happiness
in life. Former Yale University Provost Jaroslav Pellikan, a noted scholar,
has proclaimed the end of total reliance on rationalism and the Enlightenment:
"A third intellectual virtue is a sustained, if not significantly chastened,
trust in rationality and its processes. For a variety of reasons, such a trust
has been challenged by an awareness of its fallibility and its limitations.
It seems imperative for the university to develop a deepening appreciation
for other ways of knowing and thinking which cannot be accommodated easily
to the criteria of the Enlightenment and rationalism."1